We’ve been watching Doctor in the House avidly here at personalmedicine&me. It’s great to see personal medicine helping improve so many lives. Emma’s story about a lifetime of anxiety and depression is one of many moving stories about how we can come to accept chronic health issues as simply “who we are” rather than something we can change. We spoke to Anne Catherine Faergemann, a functional medicine practitioner at Nordic Clinic in Copenhagen to find out more about how a functional approach can help with anxiety related problems.
Do you get patients coming to the clinic who have problems with anxiety?
Yes, over the years I’ve had a number of patients with varying levels of anxiety who have approached either with anxiety as the main thing they want to deal with or as part of a number of problems they are having. But as always with functional medicine it’s a personal approach where we have to find the right solution for the patient and they may all respond to different approaches within the functional medicine palette.
What kind of interventions can be helpful?
One area that has been helpful with a number of patients has been working with fats like fish oil because the EPA and DHA in the fish oil impacts the plasticity in the brain so it can make the brain more adaptive or more flexible. By doing that the neurotransmitters like serotonin and dopamine, that helps our happy mood, can signal better in the brain. So there is clinical precedent for working with fish oil.
Can diet be helpful as well as supplements like oils?
Yes. Sometimes we’ll explore working with a gluten and casein free diet. The theory there, is that if we maldigest gluten and dairy protein we may produce some morphine like proteins that can impact how a person behave or feel.
Then of course there is general nutrition, making sure you eat enough protein, so you have enough “building blocks” for optimal production of serotonin or dopamine. Also, a balanced blood sugar is highly important and of course ensuring, that the diet is well balanced with enough fruits and vegetables can help. Compounds like vitamins and minerals and fatty acids may need to be added to the diet to address any imbalances.
And how about with the fish oils? Should that come from eating lots of fish?
You can get it from fish, but you need to consider what fish you’re eating. The smaller the fish and the oilier the better the source so you should look at sardines, mackerel maybe salmon. But the problem with salmon is a lot is farm grown now and the fish are restricted on the intake of algae, and this leads to less accumulating of EPA and DHA. We can’t expect the level of EPA and DHA in salmon to be as expected in nutritional calculations, because they are out dated. Taking an extra supplement of fish oil would be a good thing.
Fish oil is quite an easy supplement to come by. Will any fish oil do?
In regard to fish oil you want it as fresh as possible and as non-polluted as possible. You don’t want it to be rancid or polluted with heavy metals. Some manufacturers are quite open about level of rancidity and toxicity. We’re talking about mercury of course but could also be PCBs or other chemicals. With that in mind you need to look out for the brand and ask these questions.
So, is functional medicine the solution to anyone experiencing anxiety?
In functional medicine we try and incorporate as many angles as possible because it’s never really just one thing that fixes the problems. But let’s say that dietary changes reduces anxiety in a patient significantly, then there may still be some behavioral patterns you need to change and it can be good to support that with a counsellor or a therapist and perhaps it might also be supported with a massage or body therapy. It’s difficult to say what is the right thing for each person, but if someone doesn’t want to go to a counsellor again because of a bad experience that’s not the place to start. Exercise is also important, just moving or doing yoga can release dopamine. Movement has a positive impact on how we feel. There can be many ways of addressing anxiety or any other condition, so it’s just a case of finding the best way for the patient.
So, a multi-practitioner approach can sometimes be the answer?
Yes. I had a patient with severe social anxiety, she’s been doing counselling and it is actually the psychologist who referred her to come and speak to me about her nutrition and working with nutritional supplements so it can come either way round. And she’s incorporated small things like walking and a little core strength, hence experiences small successes by taking small steps.
So, if you had to sum up the advice for someone who is experiencing levels of anxiety what would you say?
Find a practitioner you trust and get wary about anyone who has a single answer to your problems. Things like diet and fish oil supplements and exercise may well help but it’s important that the solution is tailored to you and to your own biochemistry and behaviours. Functional medicine is personal medicine. It’s about working with someone to find what’s right for you.
About Anne Catherine
Anne Catherine is a clinical dietician at Nordic Clinic in Copenhagen. She trained at the University of Aarhus and holds an MSc in Nutritional Medicine from Surrey University in England. To find out more about how you can find a personal medicine practitioner to help improve your own health, click here.